Objective: Long-term use of ecstasy is known to be a risk factor for structural brain damage and psychosis. Most patients suffering from ADHD in childhood will not develop psychosis during adulthood but the risk is increased when there is concomitant significant drug use. However, it is difficult to distinguish between substance-induced psychoses with schizophrenic psychosis.
Method: We report a case of a patient with history of ADHD who was untreated, who later developed psychotic symptoms soon after initiation of ecstasy uses. The symptoms persisted despite in a ‘drug-free period’ and intensified while on the ecstasy.
Results: Present case helps to understand common neurobiological mechanism behind psychosis and brain atrophy, and risk factors such as ADHD and ecstasy abuse.
Conclusion: More research in this area is vital for management and further understanding on the importance of treating ADHD earlier and to be more vigilant in establishing the history of substance use.
Objective: Pritchard Criteria are adopted in a Malaysian criminal-justice system while assessing fitness to plead. There is limited data on the reason of unfitness to plead for female offenders in Malaysia.
Methods: A case series of five patients hospitalized to Hospital Bahagia Ulu Kinta, Malaysia due to unfitness to plead was presented and discussed.
Result: The offences include three homicides, one assault, and one stealing. All of them were diagnosed to have schizophrenia with prominent looseness of association. Four of them subsequently treated as Treatment-Resistant Schizophrenia (TRS) with a minimal response toward clozapine.
Conclusion: Looseness of association may be a contributing factor for unfitness to plead among Malaysian female offenders, which can result in indeterminate hospitalization. This should be confirmed in a larger prospective study.
Objective: The purpose of this study was to determine the level of psychosocial burden and its associated risk factors among women with abnormal Pap smear and post colposcopy.
Methods: A cross-sectional study was conducted employing universal sampling of 218 respondents with abnormal Pap smear and post colposcopy. They fulfilled the specific inclusion and exclusion criteria. Three tertiary hospitals in the East Coast of Malaysia were participated. Self-administration of validated Malay-version Psychosocial Effect of Abnormal Pap smear Questionnaire was used to assess the psychosocial burden. The General Health Questionnaire-12 (GHQ-12) was applied to assess the general health factor. Data was analyzed using IBM-SPSS of version 22.
Results: The results showed that respondents with an abnormal Pap smear and post-colposcopy women (43.1%) demonstrated a high level of psychosocial burden. The significant risk factor of psychosocial burden was living in an urban and semi-urban area of residence (p≤0.001) and distress condition (p≤0.001) respectively.
Conclusions: A substantial number of women with abnormal Pap smear results were experiencing psychosocial burden. Women with an abnormal Pap-smear who were living in the urban and semi-urban and distressed were more likely to experience a higher psychosocial burden.
Objective: A quick assessment tool for screening individuals with depression or anxiety is pertinent in mental-health set up. This study aims to validate the K10 and the K6 to screen patients with non-specific
psychological distress in a Malaysian population.
Methods: Translation of the questionnaire was done from English to Malay. Face validity was conducted on patients, and a pilot study was performed to assess the reliability of the K10 questionnaire. Fieldwork was conducted to determine the reliability and validity of the K10 questionnaire based on convenience sampling of healthy individuals and patients diagnosed with psychiatric illness. Malay version for K10 was administered to healthy participants (group without psychological distress) and patients on psychiatric clinic follow up (psychological distress). Data collection was done between August 2016 and September 2016.
Result: A total of 94 subjects were recruited in the study, of which 32 formed the case group. The Cronbach’s alpha coefficients for K10
were 0.837(control) and 0.885 (case), as for K6 were 0.716 (control) and 0.859 (case). The total score of the
K10 and the K6 clearly differentiated between the control and case groups (p
Introduction: Kratom (Mitragyna speciosa Korth) dependence is a common psychiatric complication associated with regular kratom use in Malaysia. Hence, it is important to assess the severity of kratom dependence among regular kratom users. The Kratom Dependence Scale (KDS) was introduced to evaluate the degree of severity of kratom dependence among users. This study aimed to translate the original English version of the KDS into Malay and examine the psychometric properties of the KDS (Malay) among Malaysian kratom users.
Methods: Initially, parallel translation and back translation of the original English version of the KDS was performed. The KDS (Malay) then was administered to 20 active Malaysian kratom users to assess face and content validities in a pilot study. Finally, the final version was administered to 150 active kratom users to evaluate its internal consistency (Cronbach’s α), face and content validities, discriminative validity, and construct validity, i.e. via exploratory factor analysis (EFA).
Results: The KDS (Malay) Cronbach’s α of 0.94 exhibited excellent internal consistency. It also demonstrated construct validity, as EFA showed that all items of the KDS (Malay) fit into a single domain, similar to the original English version. Discriminative validity was also demonstrated by the KDS (Malay), as it could differentiate kratom dependent users from non-kratom dependent users.
Conclusion: The KDS (Malay) has acceptable psychometric properties and is suitable to assess severity of kratom dependence in Malaysian kratom users.
Objective: Smart phones have become an important part of human’s life, including the healthcare population and medical students. However, pathological use of smart phones could lead to smart phones addiction. The aim of this study is to observe a pattern of usage of smart phones among the medical students and staffs in the Faculty of Medicine Universiti Teknologi MARA (UiTM) and screen for smart phone addiction among the respondents.
Methods: A cross sectional, quasi-experimental study design involving medical students and staffs in the Faculty of Medicine Universiti Teknologi MARA (UiTM) was employed. A total of 598 respondents was approached to participate, and all consented to this study. Measurements used in the study include a self-developed questionnaire to measure pattern of smart phone usage and Smart phone addiction scale (Malay version).
Result: We found that 65.9% of the respondents were heavy users of the smart phone (more than 3 hours daily) and majority of them were using it for social networking. More than half of the respondents (52.2%) were at risk of developing smart phone addiction based on Smart phone Addiction Scale (Malay Version).
Conclusion: This study revealed that medical students, and the faculty staffs were heavy users of smart phones, and they were at risk to develop smart phone addiction.
Objective: Suicide pacts are rare subsets of suicides amounting to less than 1% of suicides globally. Usually, there is one dominant participant to persuade the other by their shared experiences to agree to the suicide pact. There is also the perceived loss of a partner (which is a contributing factor in about 20% of cases) with the impending death of one member acting as a trigger.
Methods: We report a 46-year-old Burmese lady who presented with deliberate self- poisoning immediately after the death of her husband to honour a suicide pact they made. She had no previous history of psychiatric illnesses. The pact, initiated by her husband, was well planned six months prior to his death.
Result: She was discharged well after a thorough medical evaluation and supportive therapy. Input of family members knowledgeable in Buddhism helped allay her obligation to the pact citing religious reasons.
Conclusion: The case highlights a suicide pact that was initially unrecognised in the ward. In a multicultural country, psychiatrists need to be more sensitive and aware of erroneous beliefs that may lead to a suicide pact.
Objective: Lysergic-acid-diethylamide (LSD) users are the hidden population of drug users as they do not present to medical personal for treatment. The method of transporting the drug is usually by-pass the law enforcers’ monitoring. We describe a rare case of LSD use in Malaysia Novel Psychoactive Substances (NPS) which is difficult to capture as LSD users remained as a hidden population of drug users in the country.
Methods: We reported a 23-year-old male with chronic use of Lysergic-acid-diethylamide (LSD) presented with retrospective history of acute intoxication. Later, he presented with depressive symptoms, occasional flashbacks and physical complications such as premature ejaculation (PE), urinary incontinence, reduced sweating and headache despite abstinence from LSD and other drugs. The reported physical complications remitted after 4 months of abstinence.
Result: Our case report suggested that LSD use not only causes acute intoxication but leads to several complications, which may persist even after cessation of LSD use.
Conclusion: This case-report had pointed out the importance of future studies to look into the complications of LSD and the case-report as well demonstrated the harmful psychological and physical effects of LSD use, which would warrant proper surveillance and interventions curbing the emergence of LSD use in Malaysia.
Objective: Bradycardia due to the combination of amisulpride and fluvoxamine is not commonly known in the literature.
Methods: We report a case of asymptomatic sinus bradycardia that occurred when amisulpride and fluvoxamine were given concurrently and resolved after cessation of both these two medications. The Naranjo scale for Adverse Drug Reaction was used to determine the likelihood of medications’ in causing bradycardia. Other possible causes were also assessed and ruled out through medical consultations.
Results: This case strongly suggests that the bradycardia occurred due to the combined effect of these medications’ independent risk in causing this potentially harmful cardiac event.
Conclusion: Therefore, it is important to monitor for bradycardia whenever both these medications are prescribed even at therapeutic dosages.
Objective: The objective of this study to assess the comparative effectiveness of exposure and response prevention (GERP) and cognitive-behaviour therapy (GCBT) in a group of Iranian patients with obsessive-compulsive disorder (OCD) and comorbid depression symptoms (CDS).
Methods: Ninety OCD patients were selected (both genders, married or unmarried and ages from 18-65 years) using a non-probability sampling (availability sampling) procedure. The respondents subsequently sampled via cluster randomization into three equal groups: a control group (n = 30) that did not receive any treatment intervention during the study and two other groups who received 12 weeks of psychotherapy in the form of GERP (n=30) or GCBT (n=30). This study obtained the required data through a clinical interview with all participants based on the diagnostic and statistical manual of mental disorders text revision (DSM-IV-TR). The statistical analysis was performed using analysis of variance (ANOVA), Bonferroni correction and Pearson correlations.
Result: We found that GCBT and GERP are effective treatments for alleviating OCD symptoms among patients. The results demonstrated that OCD scores were significantly reduced among participants after receiving GCBT and GERP treatments, with mean (standard deviation, SD) changes of 0.829 (0.287) and 0.970 (0.258), respectively. The study measured CDS through the Persian-language version of the Beck Depression Inventory-II (BDI-II-PERSIAN). The study further found a significant correlation between OCD and CDS. The findings suggested that GCBT and GERP improved comorbid depression symptoms (CDS) significantly with mean (SD) changes of 13.57 (3.92) and 12.85 (4.50) respectively.
Conclusion: GCBT and GERP separately produced equivalent improvements for OCD and CDS.
Introduction: Psychotherapy is a form of treatment intervention targeting problematical human behaviour, emotion, and cognition using various psychological techniques and approaches. In Malaysia, the application of psychotherapy in ameliorating criminality among forensic populations is developing and evidence shows that some therapies like Cognitive-Behavioural Therapy and Reality Therapy have been practiced in many correctional institutions.
Objective: This paper aims to review the role of psychotherapy for help in correctional settings as a means to ameliorate criminal behaviour and reduce recidivism rates.
Method: An archival research was utilised, where articles and books regardless of the year of publication from different countries, including Malaysia were examined. Several keywords were used for the purpose of retrieval of related articles.
Results and Discussion: Three different approaches of psychotherapies, i.e. Behavioural Therapy, Cognitive Therapy and Cognitive-Behavioural Therapy and their principles and effectiveness in rehabilitating the forensic populations were elaborated in this review. The principle behind the effectiveness of the psychotherapy was different, and this influences the choice of treatment that should be used in dealing with the forensic populations.
Conclusion: Forensic populations have rights to obtain treatment, and the choice of therapy has to be relevant within the context of cost-effectiveness to ensure optimum effectiveness in ameliorating criminal tendencies.
Objective: ADHD is a complex neurobiological disorder, which required tactful
intervention. Besides pharmacotherapy, there is still limited information in
addressing the efficacy of cognitive behavior therapy (CBT) for treating this
developmental disorder.
Methods: We report a case of late diagnosed of ADHD
whose facing difficulty to cope with her undergraduate degree. She has to repeat
her semester examination due to lack of attention. Denial was seen in both
patient and family in accepting the diagnoses, and posed roadblock for
successful intervention.
Results: Six sessions of CBT were conducted, coupled
with psycho education for both the family and patient. Consultation from the
university’s management helped her to accept and cope with her ADHD
symptoms, i.e. attention and impulsivity. The patient showed improvement
following this intensive bio-psycho-social intervention.
Conclusion: The short
duration of CBT was found suitable to be adapted and implemented in young
adult ADHD.
Objective: Mental health is often stigmatized in Asia, and electroconvulsive therapy (ECT) is portrayed negatively in the media. The objective of this short report is to obtain an insight on Asian countries’ perception on Electroconvulsive Therapy, mainly through the media.
Methods: Several online movie databases were searched, with emphasis on Asian movies’ portrayal of Electroconvulsive Therapy.
Results: Electroconvulsive Therapy (ECT) was portrayed in 9 television programme, 4 in films and 2 on Youtube. All patients (15) had no proper information given on possible side effects and consent not taken in all of them. 5 patients (33%) were tortured via ECT, 3(20%) of them had, ECT for Schizophrenia. In all scenes (15/15, 100%) ECT were given without general anaesthesia and the patients were fully awake. Basic monitoring (2/15, 13%) was performed, and all patients had no oxygenation. Tonic Clonic seizures were visible because all patients received no muscle relaxant. Bilateral electrode's placements (13/15, 87%) were common. One (6.6%) patient had a trilateral electrode placement. Most patients (9/15, 60%) received one shock, 4 patients (27%) received 2 shocks. One patient (6.6%) received 3 and 1 patient (6.6%) 4 shocks. 100% of patients were in obvious discomfort and ECT was portrayed as barbaric. There was no death depicted post ECT.
Conclusion: ECT is under portrayed in the Asian media. Only the Indian and Pakistani medium broached the subject. In the majority of the scenes, ECT was portrayed
negatively. This shows a total lack of knowledge of ECT among the Asian population. Alarmingly, ECT was used as a torture device in 5 mediums. This only adds to the stigma of ECT in Asia. More needs to be done to correct the misconceptions of ECT in Asia.
Objective: It is important to investigate the association between spousal support
and psychology of cancer patients, thus a validated instrument to measure the
degree of perceived spousal support is required. We translated and evaluated the
psychometric properties of the Sources of Social Support Scale-Malay version
(SSSS-Malay) among Malaysian cancer patients.
Methods: In this study, the
SSSS-Malay and Hope Scale-Malay [used to compare with the SSSS-Malay to
assess discriminant validity] were administered to 195 Malaysian cancer patients
during baseline assessment. The SSSS-Malay was re-administered 2 months
after the baseline assessment during follow-up.
Results: The SSSS-Malay total
score (Cronbach’s α = 0.70, intraclass correlation coefficient (ICC) = 0.72) and
its domains (Cronbach’s α ranging from 0.70 to 0.83, intraclass correlation
coefficient ranging from 0.6 to 0.76) exhibited good internal consistencies and
good test-retest reliability. The SSSS-Malay also demonstrated good convergent
and discriminant validities. However, confirmatory factor analysis of the SSSSMalay
showed that it was best fit into a 3-factor model instead of the 4-factor
model of the original English version.
Conclusion: The SSSS-Malay
demonstrated good psychometric properties for use in Malaysian cancer
patients.
Introduction: Posttraumatic growth (PTG) is a positive psychological change in
life that occurs as a result of struggle with highly challenging life crises. There is
a growing need to explore posttraumatic growth (PTG) in cancer patients, as
higher PTG may enhance well-being of patients.
Objectives: The aim of this
study was to translate the Posttraumatic Growth Inventory-Short Form (PTGISF)
into the Malay language and evaluate its psychometric properties for
assessing Malaysian cancer patients in future studies.
Methods: Two parallels
forward and backward translations of the PTGI-SF into the Malay language
were conducted. The test was administered to 195 cancer patients. Reliability
was evaluated by testing internal consistency (Cronbach’s α) and calculating the
test-retest intra-class correlation coefficient, and validity was examined by
determining face, convergent, and discriminant validities and using
confirmatory factor analysis (CFA).
Results: The Malay version of the PTGI-SF
and its five domains demonstrated good internal consistencies and acceptable
test-retest reliability. All 10 items of this version were highly correlated with
their own domains and thus exhibited convergent validity. Discriminant validity
was achieved, as all domains of the Malay PTGI-SF was not highly correlated
with the domains of the Source of Social Support Scale. CFA resulted in a bestfitting
5-factor model.
Conclusion: The Malay version of the PTGI-SF is a
suitable tool for measuring PTG in Malaysian cancer patients.
Objective: Sexual problems are common among patients who are on antidepressants treatment. The objective of this study is to determine the prevalence of PE and ED, and their potential risk factors that may impair their sexual function in a TH
Methods: A cross-sectional study using simple random sampling was conducted among adult male patients who are on antidepressant treatment in the TH psychiatric outpatient clinic. Respondents’ sociodemographic data were obtained. Participants were interviewed using a structured self-report questionnaire with 15-item International Index of Erectile Function (IIEF-15)where the scores lesser than 25 were indicative for having an ED. A validated Malay Premature Ejaculation Diagnostic Tool (MAPET) was used to assess PE and those with a score ≥ 23 were considered to have PE.
Results: Hundred respondents were participated, and the prevalence of PE and ED was 66% and 85%, respectively. Using multivariate binary logistic regression, the potential risk factors of PE were race, i.e. being non-Malay (p=0.044), lesser in the frequency of sexual activity (p=0.03) and also an ED (p=0.03), respectively. The only risk factor for ED was PE (p=0.026). No significant association was noted for the other factors, including type of the antidepressant, dose and duration of antidepressant used (p>0.05). There was a strong correlation of MAPET and IIEF-15 (r=-0.345, p < 0.01) signifying patient with more severe PE had more severe ED.
Conclusions: Due to very high rate of ED and PE in this group of respondents, it is pivotal to screen for sexual problem among patients who are taking an antidepressant in a psychiatric setup.
Study site: Psychiatric clinic, Pusat Perubatan University Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia.
Objective: This case report highlights a case of young male referred for psychiatric evaluation due to paraphilic disorder. This 27-year old single male working as an assistant accountant was noted to have voyeuristic behaviour and presented with depressive symptoms since his teenage age. He has poor coping whenever he experiences stress in life. He started to watch pornographic videos and subsequently get involved by peeping pre-pubescent’s undergarments. These activities are followed by a compulsive behaviour such as masturbation to gratify his sexual arousal.
Results: The patient undergone several psychotherapy sessions, and medical report was furnished for the court's purpose. Our assessment revealed that he was suffering from a lifetime major depressive disorder,and he was prescribed with Tablet Sertraline 50mg/daily.He also has premature ejaculation, severe in nature. He regretted his voyeuristic urge and psychotherapyfocused on how to channel his sexual needs.
Conclusion: Mood disorder is seen in paraphilic disorder and has to be dealt with in order to establish good management care.
Objectives: With the explosion in the use of WhatsApp Messenger globally, the revalence of late-night WhatsApping is poised to show a commensurate increase. This has sparked debates on a possible new wave of technological addiction that could cause serious psycho-behavioral repercussions. Acknowledging the ubiquity of WhatsApp, healthcare professionals have adopted it as a preferred communication tool in clinical practice. This preliminary cross-sectional study aimed to explore the prevalence of and psycho-behavioral factors associated with late-night WhatsApping.
Methods: It was conducted on a universal sample of 307 healthcare professionals across medical and casualty departments in a Malaysian public hospital. The self-administered questionnaire consisted of items on socio-demographics, WhatsApp usage characteristics, and psycho-behavioral attributes.
Results: Majority of respondents (72.9%) reported late-night WhatsApping habits. In multivariate analyses, late-night WhatsApping was significantly higher among those who used WhatsApp for more than 12 months (Adjusted odds ratio, AOR = 4.4, 95% Confidence interval, CI 2.2–8.8, p < 0.001), those who frequently kept
mobile data on to avoid missing WhatsApp messages (AOR = 3.2, 95% CI 1.3–5.8, p = 0.006), those with frequent social connections (AOR = 3.0, 95% CI 1.4–6.4, p = 0.003), and those living alone (AOR = 2.3, 95% CI 1.1–5.2, p = 0.038).
Conclusion: Late-night WhatsApping was significantly associated with usage characteristics and psycho-behavioral attributes.
Objectives: This study investigated the relationship between coping skills and
psychosocial adjustments among parents of children with LD.
Method: A
cross-sectional study with a convenience sampling method was applied to a total
of 87 parents of children with LD from four non-government community
rehabilitation centers. They were measured using a validated Malay version of
the Family Crisis Oriented Personal Evaluation Scale (F-COPES) for coping
skills. The Modified Psychosocial Adjustment to Illness Scale-Self-Report
(PAIS-SR) was used to measure parents’ psychosocial adjustments.
Results: A
Spearman’s rho showed a correlation between total coping skills and
psychosocial adjustments scores among parents (rs= -0.43, p
Objectives: This study aimed to determine the prevalence of depressive disorder
and its association with perceived social support among patients with HIV
attending the Infectious Disease Clinic in HTJS.
Methods: A cross-sectional
study was conducted, and systematic random sampling method was employed
for the selection of participants. Socio-demographic and clinical details were
obtained through a self-rated questionnaire and participants’ medical records.
Depressive disorder was screened and diagnosed using the Mini International
Neuropsychiatric Interview (M.I.N.I.) and perceived social support was
determined using the Multidimensional Scale of Perceived Social Support
(MSPSS). Appropriate statistical analyses were used to determine the prevalence
of depressive disorder and its association with perceived social support.
Results:
A total of 99 patients participated in this study. The mean age of participants
was 38.16 ± 1.01 years, and the majority of participants were male (69.7%). Most
of the participants were Malay (58.6%), followed by Indians (20.2%), Chinese
(17.2%) and others (4.0%). The majority had completed secondary education
(54%), and most were employed (79.8%). Most of the participants were single
(45.5%) or married (45.5%). The lifetime and point prevalence of depressive
disorder was 24.2% and 17.2%, respectively. About 64.7% of patients with
depressive disorder were undiagnosed. Out of the 3 sources of perceived social
support, perceived social support from a significant other (OR=0.53, p=0.042,
Cl=0.29, 0.98) and perceived social support from friends (OR=0.49, p=0.015,
Cl=0.27, 0.87) were found to be negative predictors for depressive disorder.
Conclusion: This study reports that the prevalence disorder among patients with
HIV in HTJS is higher than that of the general population. Patients without
depressive disorder reported significantly higher perceived social support scores.
Perceived social supports from significant others and friends were found to be
important associated factors for lower depressive disorder vulnerability. Hence,
physicians should routinely screen for depressive disorder in this vulnerable
group and explore and mobilize their social support to reduce patients’
vulnerability to develop depressive disorder.